Improving the NHS… small changes —> big effects : Suggestions?

Arthuritis

A mother-of-two collapsed and died after having suffered a fatal haemorrhage at a crowded A&E department

The 39-year-old had been waiting for at least seven hours at Queen’s Medical Centre in Nottingham before she was discovered unconscious under a coat.

The woman first attended A&E in the late hours of January 19 complaining of a severe headache.

She was triaged and observed three times by nurses and while her case was escalated, she was not seen by a doctor before being discovered. 

—> The first hour after any medical incident is known as the “golden hour”, with the best possible chance of recovery if seen promptly. 

Why not move one of the A&E docs out of A&E and into triage as part of triage shift rotation? They will successfully save more lives that way than struggle hours later too late when God himself couldn’t save them. Yes, waiting times might get longer, but deaths and adverse outcomes will be greatly reduced. 

Many serious conditions are difficult to assess even for a doctor let alone a receptionist or nurse. 

Meningitis looks like flu

Diabetics without insulin appear intoxicated

Stroke victims can also look appear intoxicated

Poison victims can appear well, but have only minutes before their condition becomes irreversible

Patients will be less stressed  because  they know that they have been assessed by a doctor licensed to practice emergency medicine, and not the receptionist in a bad mood or a nurse neither qualified to diagnose or assess. Both would benefit from not being asked to do what they are not qualified to do. 

The A&E docs would benefit because they know they are unlikely to receive as many unrecoverable cases. 

Problem 2: Drug interactions & contraindications missed

NHS Patients often suffer serious adverse effects of prescribed medicine when two contraindicated  medications are prescribed, one by the hospital, the other by the GP. The prescribing doc is supposed to take a detailed medication history and check contraindications at different dosages (sometimes bad things happen only when two drugs are prescribed at above a certain dosage). These checks often don’t happen because docs are busy or the gp does not know what the hosp has prescribed. They all go through the same NHS prescription system. Why not have the NHS prescription database hold the history and do laborious automatic contraindication checks which it could easily do, as a machine, rather than rely on fallible human docs? 

Problem 3. Impossibility of booking or changing bookings on NHS leading to £1bn annual loss (NHS figure). 

Why does every NHS hospital, consultant and gp surgery need to invent and waste money on its own uniquely invented run-in-a-silo booking system, when it’s supposed to be a National Health System? 

Why not copy the commercial model where money does not come from a bottomless tax payer pocket and has to be earned? HCA has a booking system that works across all their GPs and surgeries, restaurants have OpenTable … Instead of wasting money on separate booking systems that are impossible to change anything on without calling the receptionist secretary of every consultant involved in a procedure, and then blaming patients for an annual £1bn “no-show” loss because the patient has given up trying to contact the hospital to change the booking… This should be a single common system. Some London hospitals have taken the initiative to sign up to “MyChart”, an American patient booking mgmt system, and it’s better than any cooked up by the hospitals individually but this is just that small handful of hospitals. Why is there no effective NHS leadership to use taxpayer money wisely? 

Can anyone suggest any more additions?

@Trish9556 @frogmorton @Hairobsessed123 @noddingtonpete

I want to put these to my hosp patient committee but would like to sound these out here with this community of NHS frequent flyers! 

Trish9556

Hi @Arthuritis

How to improve the NHS? a tough one.

I think the problems with the NHS started when they separated it into diffferent health authorities and stopped centrallised services like catering, maintenance, purchasing, cleaning etc. This in itself wastes a huge amount of money with each authority choosing their own suppliers at stupid prices and in the case of catering, maintenance and cleaning, because they're not in house employers they have no pride in the services they provide. The decentralised system also has two many paper pushers who know nothing about working in the NHS and these paper chasers all get given a stupid amount of money in salaries. This all means that money isn't spent where it's needed, the NHS providers - nurses, doctors, consultants, equipment etc and all of these are overworked to the point of exhaustion.

Triage is initially carried out by a nurse qualified (I hope) in a & e. Nurses used to be trained in an apprenticeship programme, living in, paid a wage and learnt from the bottom up starting with emptying bed pans, operating the sluice, taking temperatures etc. Now they have to receive a university education, at a cost to themselves, getting themselves into debt, learning exactly the same as a nurse learning on the job. Basic jobs are now done by what they used to call ward orderlies. Do nurses learn the job, and learn to love the job better the new way or the old way with matron guiding them in making beds, hygiene and teaching them nursing as they go, helping out with rounds etc? I'm not sure.

Triage is then followed up by a junior/newly qualified doctor/registrar who have worked too many hours on one shift on call and often too tired to do the job properly. They are often unsupervised and their work is often not checked unless something goes wrong. Example: My husband stabbed himself with a fork while preparing potatoes for baking (please don't laugh too much) between his thumb and forfinger. His hand swoll quite badly and I told him to get to A & E to get it checked out the next day. He was triaged by a nurse and then the junior doctor. The junior doctor told him it was fine, dressed it and said if it got worse to go back. He already had a red line going up his arm. Two days later he was taken back to A & E and seen by a consultant. The consultant wasn't happy at the original diagnosis and I believe the dr concerned had what we used to call a rollicking. The red line had crept up above his elbow, he had blood poisoning. Taken into surgery immediately where the infection was cleaned out and put on antibiotics with follow up appointments by the same consultant. Why did the junior doctor not pick it up? Probably too tired or too new and should've been monitored by a more senior doctor. I dread to think what would have happened if I hadn't got tough with my husband and sent him up to A & E twice accompanied by my sons so he didn't escape.

Both of these end up with budgetary reasons. Centralise services again. Cenrtralised services mean you pay less for it. Get rid of overpaid pen pushers as well and by doing these basic things you have more money to put where it's needed so you can payh more staff where the staff are needed.

Nurses and doctors are well known for also working as agency staff between shifts. Agency staffing costs a horrendous amount of money. Pay staff the proper wage and then they won't need to work as agency staff. They will then be able to rest properly between shifts and not be too tired to work.

There are far too many apps for the NHS which we are all expected to use. We have patient access for our doctors surgery, we have the NHS app which came later and does exactly the same as Patient Access yet, when COVID came along we had to have the NHS app before we could get the COVID app to book our COVID tests/report results and book COVID jabs - why couldn't this have been done via the NHS app? Who paid for the NHS Covid App to be developed? Who made the decision for the NHS Covid app to be a separate app? We also have Ask First which is supposed to enable you to get triaged online - I think this used to be 111 which we can still use and get to speak to a real person but now we have an app. Why do we need another app? We're supposed to be able to book drs appointments using this app. It doesn't work. Example: My daughter in law was ill at the weekend with something she had had before and been told to go to A & E next time it happened. Who want's to visit A & E at any time of the day let alone the weekend and sit there for possibly days before they're seen? She opted to be triaged by the Ask App. The app arranged for a doctor to call her. The doctor called her and agreed she could wait to be seen by her GP on the Monday and duly booked an appointment for her to be called (nobody gets to see their GP anymore) by her GP on the Monday morning. She didn't get the call. We have to wait until 18.30 for call backs by which time if you haven't had your call back you can't call and ask why not. She emailed the surgery and complained that evening. On the Tuesday morning she got an email (no call) saying the dr would call her. The duty dr called her and told her to come into the surgery and gave her an appointment. When she arrived for her appointment she was being seen by a male GP for a personal female problem. Rather than get a female to sit in with the examination the dr got a NURSE to do the examination. The nurse hadn't looked at her history with this problem and said she was ok. Now my daughter in law had some antibiotics that were still in date which she had been given previously for the same problem which had needed surgery so she took those and promised me she would go to A & E if it didn't clear. Luckily it did but this was not the treatment she should have had after having Sepsis last time with the same problem.

If I see a consultant in a different health authority to mine, he can't see my records. He can't email my doctor on his system unless my GP gives him permission. He has to dictate a letter to his secretary to type up, digitally sign and post by snail mail because they're not allowed to email it. My GP then reads the letter when it's received and up to 6 weeks later it's scanned by the admin staff and put onto the GP's system for my local health authority.

part 2 to follow

(apologies for any escaped typos)

Trish9556

part 2

I believe (unless it was in a drug induced stupour) that they have been talking for a very long time about centralising the NHS system so there is one for the whole country. It's still not happened and from personal experience I wouldn't hold much hope for it. Example: When my notes where digitalised we were invited to check the system online (using Patient Access) and advising the surgery if there were any discrepancies. There was, I had been accused of having heart failure/attacks. I have never had any form of heart attack/failure and in need of care as a result It took SIX MONTHS for this to be removed from my record. I have had many occasions where patients paper records have been scanned and added to my record when they haven't been mine. One was the results of a womans mammogram and had her name/address/dob/phone number and results on. Luckily the results were negative but what would have happened if they were positive? She wouldn't have known for a very long time. I phoned the surgery immediately I saw her record and 18 MONTHS later they were removed. I don't know what happened as a result of the data breach. Perhaps I should've contacted the woman concerned and told her about it.

The NHS does need a centralised system that everybody has access to their own system, not just what they want you to see on Patient Access or the NHS app or any other app, where everybody, dentists/doctors/consultants/physios in the NHS and privately can see and access your records and which will be updated nationwide immediately and you can see your detailed records, book appointments and change appointments without hanging on the phone for hours before you get cut off or told that there are no appointments and phone back after 8 am the next day (impossible). More importantly though it has to work and it has to work properly. It should be triaged by staff and patients alike to make sure it works before it goes live. Once it goes live all other programmes should be removed/deleted/smashed to smitherines and bashed with my inflatable mallet. Paper communications should be relegated to the recycling bin after being shredded multiple times.

I'm lucky enough to have my prescriptions now delivered immediately to a pharmacy that gives me an efficient service, unlike the last one (a form of footwear) next to my surgery took 2 weeks to process a prescrition after it has been sent on the same day I ordered it. Why? They're too busy doing health checks/flu/covid jabs to deal with my repeat prescription and I should order it in advance of needing it. I do, I can't order it any more in advance otherwise I'd be ordering it as soon as I picked up the previous one.

The NHS is broken and the reason it's broken is there are too many people in this country for too few doctors/hospitals/dentists/A & E departments. Closing A & E's not building new surgeries when new houses are built, not having walk in centres, the list goes on. The list gets bigger and longer because they don't have enough money. They don't have enough money not necessarily for lack of funding but because the money isn't spent where it is needed.

A centralised system that works would go a long way to erradicating the problems you mention and a whole lot more. If Dr A changes patient B's medication at a hospital appointment, the GP would know. The pharmicist would know because they would have the same system the patient would know and the consultant/radiographer/paramedic/hospital would know.

In light of the Post Office Horizon issues though who would want to take responsibility for writing/testing and implementing a system that could help instead of hinder the NHS and its patients but could also cause awful consequences if it all goes wrong.

Sorry this is so long but youve hit one of my passionate issues on the head with my inflatable mallet so I'll just go and bash myself over the head with it now. Probably not helped you with your original question either but hopefully I've given you some food for thought :)

Love n hugs

Trish with a sore head from the mallet.

(apologies for any escaped typos)

swimmer60

A huge problem for the NHS is the lack of social care for patients who are well enough to be discharged, but not well enough to live on their own. A problem that no Government has been prepared to address. The NHS swallows huge amounts of money but still it can't cope. Reform is needed but it's another political hot potato.

In other countries their NHS is funded by a mixture of medical insurance and free care for those who can't afford it.

stickywicket

I am much reminded of the old Irish joke where one guy asks another for directions and gets the reply "Well, I wouldn't start from here!"

Starting from here, though, I think @swimmer60 is spot on. Sort out Social Care and beds would be released, care speeded up and medics much happier and less likely to leave or retire. I am old enough to know people who have been devastated to realise they are a bed blocker but powerless to do anything about it. I actually remember the days of Convalescent Homes. I really don't know if they worked out better or worse than Care in the Commumity. I'm sure some abused them but others benefitted.

swimmer60

As a PS we need to divert our NHS into preventative medicine, the focus at the moment is on crisis management, eg kids going to hospital to have teeth extracted. The NHS focus is on curative medicine and this needs to change. The obesity crisis would be another example.

In our own small world here we can all see the health and well being consequences when surgery is delayed and delayed.....

Arthuritis

@swimmer60 The NHS should be looking to Japan & the US for solutions, but their management would have to extricate their heads from their arses and politicians would need a STEM education to critically evaluate any solutions proposed by their cronies and/or suppliers. When I was in the supply business I saw some excellent U.S. home assist solutions that used clever home CCTV and wrist band solutions that allowed those who could live in their own home to be watched by an A.I. System that was able to notice any change in gait, breathing, heart rate, temperature, falls, weight and immediately notify the community nurse for that area to go visit, as well as notify the local hospital if it was likely incoming complete with med history. As it was highly automated and intelligent, it was inexpensive to run and used the human clinical resource very efficiently as it knew every patient’s history so could brief the paramedic, nurse or attending on what was coming, and even offer a second opinion or caution in case a tired medic made a mistake. Japan is developing something similar as they have an aging population and theirs includes home assist robots, which are coming, with key advantages in their strength and ability to work 24x7, no concerns about putting their backs out lifting a patient! However these robots are 10years from being affordable at present.

In my area we used to have a lot of home assist community care nurses from Europe, and they were really lovely, but they have largely left following Brexit and nobody local wants to do those jobs for any money. They often want to be reality TV stars or footballers! I got to know some of these carers personally and it was so sad to see them go, and their patients left behind struggling. We even had an elderly lady die at home alone a couple of streets away and nobody noticed for 2 years.

Arthuritis

@Trish9556 Great points raised as usual Trish! Your thoughtful passion for the improvement of the NHS is what is needed in government and NHS mgmt. 

Part of the problem is how we as voters will willingly vote for smooth talking con artists, they were often part of the cool clique at school and Uni, no one took notice of the nerds  with their heads in books that now have all the real power as nerdy heads of tech & pharma companies, including the power to steer governments. Just look at Zuckbucks and Gates! 

Sadly, for most of the last 20 years our political leaders in charge of the national budget allocation were not cut from the Michael Faraday or Isaac Newton cloth, this lot could barely pass their O levels. Probably didn’t, but adept at quoting Homer while the country is in a medical emergency.

So something that you said struck me as exactly what Jeff Bezos said about Seattle City Council, and the reason why they were moving Amazon HQ out… in protest at the continually rising city taxes, but little improvement. “The problem isn’t adequate funding, it’s spend efficiency”, ie they were squandering the taxes they collected because they didn’t have to earn it. No centralised competitive tendering for supplies or services, contracts given to cronies peddling unusable products & services (where have we seen that before). State run organisations if run by really clever passionate people eg Norwegian Healthcare system, can be excellent ensuring money is wisely spent, however if run by cronies of a con artist then all the extra money will either get wasted or pocketed by their cronies in suppliers. (Where have we seen this before?). The lack of understanding of business, science and maths in our political leaders means dangerous decisions that kill are glibly made without consequence and promises made using imaginary money, and as it’s imaginary money, the promise is never delivered. 

I tried summarising your points…. 

1. correct initial triage by an EXPERIENCED diagnostician,that won’t leave those in need of urgent treatment closer to death, ideally with a younger protege to impart that triage knowledge on to and an AI over watch.
2. Suppliers should go through central purchasing with competitive tendering (eg at present suppliers knowing they have the nhs decision makers in their pockets, prevent even NHS staff from discussing pricing with other nhs regions).  
3. Fair pay for nurses so they don’t have to do agency work (I think both nurses & junior docs USED to have just enough, but after the government turned sterling’s value and purchasing power to toilet paper, they can’t make enough to survive. The answer isn’t more toilet paper money like Venezuela or zimbabwe or Turkey, but to restore the purchasing power of sterling. This is govt responsibility that no one is holding them accountable for. On the day of the Brexit vote Moggy made over £10million selling sterling short, as did his cronies, knowing that £ would plummet on leave, and despite his promises of cheaper food & clothing, cost of food has rocketed. (It has also meant that EU trained clinical staff that used to work here have left because of cost & customs restrictions, forcing the NHS to recruit from third world countries where the training is not as good, and they have to be extensively retrained here).  Unfortunately politicians literally decide who lives and who dies for their mistakes & arrogance.
4. Too many NHS apps as there is so much IT funding misspent that every hospital, consultant and IT fiefdom is able to fund their own re-invention of software that has already been built, proven and sold elsewhere. It’s like each NHS hospital builds their own version Excel, for just one specific calculation! In fact the situation is so bad that until end of covid, the only National system about the NHS was fax! The NHS has already blown £10bn on building a massive IT project that like Horizon was a failure, although thankfully enough people could see it was a flop and it never went live. The suppliers however, quaffed much champagne over the cash and never having to support a dead project!
5. Understaffed NHS with too many pen pushers and not enough clinical staff. It was already understaffed before Brexit, and after Brexit so many of the EU trained clinical staff left, and not being replaced by a new crop so the NHS has to recruit from third world countries and pay a fortune to extensively plug the training gap.

I came from PLC & Inc land if this had happened there the shareholders if the company had not gone bust, would have fried the CEO and the entire senior staff. No consequences for a govt run NHS. For IT the mantra was BUY NOT BUILD! Central purchasing was the only way, with competitive tendering, any single source crony contract without excruciating justification would result in demotion at the least, most likely sacking.

One of the things I noticed while in charge of an industry equivalent of A&E was that experienced senior consultant staff hated being on the frontline, they felt it beneath them, even though their expertise would save a lot of wasted hours and money on futile fix attempts by less experienced staff, juniors who would often try to fob people off by saying they couldn’t see anything wrong, only for them to comeback after the problem had become much worse. My Mylar mallet solution was 1. Each day on the frontline will have 1.5x pay, but each day away when scheduled would be .5x pay. The week had to be covered so there was at least 1 senior at the front. If you don’t like it, that is a resignation, and your job will be advertised immediately.

Arthuritis

@swimmer60 @stickywicket Both spot on, the NHS focus on “curative” treatment rather than prevention. Ie treat only after the patient has gone blind in one eye! The modern medical practice of diagnose, identify, TREAT the “defect” with a pharma product, with things like prevention, nutrition and actual cure considered quackery came from across the pond, around 1920 when putting the patient first was a priority. A well known billionaire of the time in the oil industry, whose own father was a travelling snake oil salesman, saw the burgeoning vitamin and pharma industry, and wanted “a piece of the action”. He set up a philanthropic foundation to fund medical school scholars at Ivy League schools, but in exchange for that cash, he insisted on having a member of the foundation on the uni boards to steer the teaching curriculum for medicine. The idea was to outlaw things like prevention as quackery (Flexner report), and it was quite subtle, referred to as “evidence based medicine”, which gave it credibility, and as with any marketing & sales, it’s about wrapping something that is true inside a whole load of worthless expensive product for sale). This meant each year there would be hundreds of trusted pharma salesmen being churned out calling themselves “doctor”, and would focus on identifying which pharma product you would have to buy to treat the “defect”. This practice went global and is the basis of med training everywhere. It’s only in recent times that doctors like Tim Spector have started to consider this may not be ideal.

This thinking had become so ingrained that when genuine caring doctors like Dr Barry Marshall (Nobel prize winner) presented evidence that would curtail pharma profits, junkets and research grants for a chronic painful condition that could cheaply be cured, he was ostracised and “cancelled” but his persistence meant that he eventually prevailed and was awarded the Nobel Prize for his discovery and shamed the medical & pharma community over their greed. He’s been the subject of some good documentaries and books and definitely worth reading about or watching the documentaries. Despite Dr Marshall having proven this, senior docs that ostracised him still have the same attitude “oh but that was different”… having learnt nothing.

Hairobsessed123

I agree with @swimmer60 !!

Also they should have hubs with different specialists for different needs but again it’s funding but in actual fact it would work eventually !

example 1 The elderly hub a specialist teams for adults that have falls or are lonely or have ongoing illnesses !

what usually happens is an ambulance is sent out which is wasted when someone could be dying !

Example 2 ! Mental health hub ! For people of any age that is suffering mental health issues including suicidal thoughts ect ect

what usually happens again ambulance is sent they get taken to A&E and discharged because mental health is not on call

the list could go on but separate hubs for different things would ease the Ambulance and A&E and g.ps

Also if we all paid for G.P appointments instead of prescriptions this would deffo stop people wasting time and for those who can’t afford it there should be some kind of benefit to help !

Trish9556

Hi @Arthuritis

I think you did a good job with the bullet points! One thing I did forget to say, is I think that once a Dr has qualified they should have to stay in the nhs setting, either in a hospital gaining further experience or as a GP. I think we are losing too many newly qualified drs - if their university fees were free and they were contracted for a period of say 5 years after qualifiying it would bridge some of the shortage.

@Hairobsessed123

I don't think we should be charged for GP appointments but I do think that if you don't turn up they you should be charged on an increasing scale. Most other businesses charge for no shows and the NHS threaten it but don't do anything about it. BUT as it's difficult enough to get through to a human being in a surgery without sitting on the phone for an hour to cancel an appointment they would need to fix the basic system first otherwise you could have people legitimately not being able to cancel an appointment at short notice for some other valid reason being charged for that appointment.

love n hugs

Trish

Arthuritis

@Hairobsessed123 Good points, in some London areas such hubs have already started appearing. Maybe it’s a pilot to see if it works, and if so, roll it out.

I don’t agree with charging for GP appointments, the point of the NHS was it should be free at point of delivery, and it assumes patients are being *wilfully* irresponsible. You are very lucky if you have an easily bookable GP.

If you have had experience of trying to get an appointment on the 8:00 AM morning rush, to be offered one weeks later, and then found things have changed in those weeks and you need to rebook, only to find it’s impossible to get through and the prospect of being charged for that would, at best seem unfair. I had to change a hospital appointment a couple of years ago, and spent 2hours on the phone to try and reach the hospital receptionist, when I finally got through the phone wait queue, it was nearly the end of her shift, but she rebooked me and told me it was all done, and a letter arrived in the post telling me of the new date. The old date came and went, and a few days later I got a snotty letter telling me I’d missed my appointment and it had cost the hospital a no-show. I called up the hospital and told them I had in fact, called in time and had a confirming letter of the rebook. She told me not to worry about it, but I insisted that it be cleared up lest my GP thought I’d been mucking about. (They sent the same letter CC to the GP). Some rummaging round for another 30min while I was on hold, she finally came back to confirm that unbeknown to me, as multiple consultants were involved in the same procedure, each with their own specialist part and their own secretary/receptionist, each needed to be separately contacted to rebook, as they don’t have a central rebooking system! How was I supposed to know any of this, and without contact details of any of them!?

In short, the bigger problem is that it’s an organisational shambles, why does each consultant need their own receptionist/Secretary working completely separately? Why is it not centralised and online where all bookings & changes are centrally cascaded by computer? It’s not rocket science, such hospital booking systems have existed for ages! The private health sector or even restaurants/hotels/service bookings make every effort to make it possible for you to be a responsible adult and cancel/change a booking online if you no longer need it, and some even send you a text message at the last chance to cancel/rebook to avoid charges, that would be quite acceptable. On the NHS some services do send SMS reminders & cancel/rebook links, but only some, it’s not consistent across all services.

With regards to prescriptions it’s not nice but I kind of understand, especially as they offer NHS pre-pay, which for ~£109 per year, covers all your prescriptions and well worth it if you have a lot of them in a year.

Arthuritis

@Trish9556 I completely agree with you re junior docs contracts, appointment issues (see my follow up post) … medic students these days do pay a fee, I think it was £12K pa, but it’s still heavily subsidised, so taking an NHS contract is fair, although I do sympathise with why many of the brightest leave because they are so frustrated with how backward the NHS mgmt is in their thinking (I got this straight from the F1 & F2 baby docs’ mouths. Not just junior docs, but researchers too, esp pathologists).

swimmer60

@Arthuritis

Interesting points and shows up massive differences in what should be a NATIONAL Health Service. eg In my experience, and it's now the 8.30 scramble, if you ring up you can always get a triage at the very least and they also have pm slots for emergencies. However, a lot of the docs work part time and you are unlikely to speak to the same one twice and I wanted to book my own doc and have not got an appointment till March 19th!

After my HRP I was sleeping so badly my daughter made me ring the surgery and the HEAD MAN phoned me back almost straightaway. Ooooer.....

swimmer60

PS! Are you all able to book and cancel appointments and order repeat prescriptions online now? That's a lot easier than trying to phone!

Trish9556

Hi @swimmer60

Yes, there are many apps available that let you see your basic records and order repeat prescriptions. I would suggest the NHS app would be the best one but there are others and my surgery told us to use patient access prior to the NHS one coming out.

You tuck the boxes under repeat medication for the stuff you need, the Dr approves it and it's sent to a pharmacy if your choice to collect when necessary. There is a wide selection of pharmacies to choose from and once chosen, all your prescriptions go there automatically. You can change pharmacies if the one you choose isn't providing the standard if service you require.

Ordering repeat prescriptions online is about the only thing working as it should at the moment.

@Arthuritis

I think we posted at exactly the same time last night lol. Great minds think alike?

Love n hugs

Trish

Arthuritis

@Trish9556 Yes we did post about the same time! Similar experiences & frustrations I guess!

Arthuritis

@swimmer60 Lucky you! The big cheese never calls me, probably doesn’t even know I exist and probably thinks I am an irritating biscuit crumb!

Trish9556

@Arthuritis

A biscuit crumb is better than a chocolate teapot!

Trish x